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From the 1/14/2022 release of VAERS data:

This is VAERS ID 120891

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Case Details

VAERS ID: 120891 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Texas  
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted: 1999-03-31
Entered: 1999-04-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC Split Type:

Write-up: (null)


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